A long time ago, when I was interning in an emergency department, several ambulances arrived at once from the site of a bombing. They unloaded three victims plus a mass of assorted limbs. As I placed an endotracheal tube in one patient, the awfulness suddenly hit me: These people had probably been sitting peacefully at home only a half-hour earlier, and now they were a mass of gore. Overwhelmed, I ...

Read more...

Psychosomatic. I learned not to use that word forty years ago, after I'd told a patient her malady might be psychosomatic in origin. She turned red, jumped up, and on her way out said, “I hope you fall into an open manhole and die!” Well, maybe I should've been more circumspect. I hadn't realized until then that people can understand “psychosomatic” in a different way than I do. I'd meant what ...

Read more...

If you attended medical school, you learned in week one that American health care started becoming scientific in 1910, with the publication of the Flexner Report. Before then, only some medical schools were authentic while many others were anything from carnival booths to outright frauds. Abraham Flexner, a respected educator, had been hired by industrial barons John D. Rockefeller and Andrew Carnegie, who were determined to bring health care out of ...

Read more...

Pretend you're a 30-year-old woman who's 34 weeks pregnant. You develop a cough while cleaning a dusty room. You put up with it for several days. After a week you realize the cough has kept you from sleeping and is creating pain in your rib cage. Time, you think, for medical attention. That should be an easy thing to do. After all, you have health insurance, and you're articulate and assertive. ...

Read more...

Many of us harbor an archaic view of what health care is, so let me offer a little history. During the past century, it's changed from Healthcare 1.0 to 2.0, and now it's Healthcare 3.0. In the early twentieth century, Healthcare 1.0 was a service, though it amounted more to personal contact than effective medicine. At best, medications and procedures were hit-and-miss, so doctors relied heavily on their relationship with their ...

Read more...

Contributors on this site regularly recommend improved doctor-patient communication. Indeed, that's one reason I'm a devoted reader. But we need to articulate exactly what “communication” is. When I ask colleagues about that word, they usually define it as what they say to patients. I can't argue with that. Yes, we need to express ourselves clearly and simply. But communication includes much more. The occasional complaints I hear from patients about their care ...

Read more...

I know a wise old forester. Ask him any question and he'll answer, “Well, now, it depends on what you want.” “Should we clear this underbrush or just leave it?” It depends on what you want. I realize this can explain any choice we've made: that is, we have what we have because, at some level, that's what we want. In that light, let me discuss electronic medical records. EMRs can be wonderfully ...

Read more...

In my practice of facilitating cancer support groups, all I do is listen to patients and their families. Consequently, I hear much about the nature of their care. They generally speak favorably about its technical aspects, and indeed these are often awesome. But when they complain, it's uniformly -- and I mean one hundred percent -- about communication. One man has been trying to get an appointment with a pulmonologist for ...

Read more...

My friend Jeremy went to an emergency room with belly pain, and soon learned he'd been blessed with a kidney stone. The staff summoned a urologist, but none was available, so they sent him home with a pain prescription. Continuing nevertheless to writhe in agony, Jeremy phoned urologists and learned to his dismay there were only three in the region who accepted his insurance, and none at all in his ...

Read more...

The acronym "MI" has traditionally meant myocardial infarct, or heart attack. Recently it's taken on a new, more salubrious meaning: motivational interviewing. A growing number of docs are practicing this technique, which amounts to listening to patients to help them recognize their internal sources of behavior. Boston's NPR affiliate, WBUR, describes typical MI interventions in which doctors, instead of demanding that patients stop smoking or drinking or overeating, gently ...

Read more...

2 Pages